Patient-rated Outcome Measures Research Articles

The Use of the Voice Trainer App for Vocal Control in People with a Degenerative Ataxia: A Pilot Intervention Study.

Dysarthria is disabling in persons with degenerative ataxia. There is limited evidence for speech therapy interventions. In this pilot study, we used the Voice trainer app, which was originally developed for patients with Parkinson's disease, as a feedback tool for vocal control. We hypothesized that patients with ataxic dysarthria would benefit from the Voice trainer app to better control their loudness and pitch, resulting in a lower speaking rate and better intelligibility. This intervention study consisted of five therapy sessions of 30min within 3weeks using the principles of the Pitch Limiting Voice Treatment. Patients received real-time visual feedback on loudness and pitch during the exercises. Besides, they were encouraged to practice at home or to use the Voice trainer in daily life. We used observer-rated and patient-rated outcome measures. The primary outcome measure was intelligibility, as measured by the Dutch sentence intelligibility test. Twenty-one out of 25 included patients with degenerative ataxia completed the therapy. We found no statistically significant improvements in intelligibility (p = .56). However, after the intervention, patients were speaking slower (p = .03) and the pause durations were longer (p < .001). The patients were satisfied about using the app. At the group level, we found no evidence for an effect of the Voice trainer app on intelligibility in degenerative ataxia. Because of the heterogeneity of ataxic dysarthria, a more tailor-made rather than generic intervention seems warranted.

Validating the COVID Check-In: A co-produced online platform enabling integrated care for people with Long COVID

Introduction: ‘Long COVID’ describes the sustained and debilitating symptoms experienced by many people following acute COVID-19 infection. This study builds on previous work by Deakin University and the Western Health COVID-19 Recovery Collaboration (WHCOVRE). In this previous work, a team of 4 health researchers and 6 consumers with Long COVID co-designed the COVID Recovery (or DisCOVeRY) model of care. This model provides a framework for appropriate and effective care by providing an integrated pathway that incorporates existing community supports, tailored to individual consumer need. Consumers receive a comprehensive biopsychosocial assessment using a co-designed patient rated outcome measure (PROM) called the ‘COVID Check-In’ (CCI), the World Health Organisation Disability Assessment Schedule (WHODAS-36), EQ-5D and the 100-point Goal Attainment Scale (GAS). Assessment outcomes determine which clinical stream is offered – self-managed (DisCOVeRY-SM) or intensive rehabilitation (DisCOVeRY-IR).&#x0D; Aim: The aim of this project was to validate the automated component of DisCOVeRY-SM for people with Long COVID. Is the CCI a valid, reliable, relevant and accessible Patient Rated Outcome Measure (PROM) for people with Long COVID?&#x0D; Methods: A quantitative descriptive approach was adopted, providing a psychometric analysis of the validity of the CCI. The CCI was delivered using “Platform O”; a flexible online research tool developed at Deakin University to meet both end-user and researcher needs. The interactive content builder fully integrates with questionnaire applications, online video platforms, animated content, and third-party interactive applications. “Platform O” also includes engagement tools (e.g., star ratings, personalised reminders) and security features to support user testing, continuous quality improvement and communication between end-users and the project team.&#x0D; All Australians meeting the World Health Organisation case description of Long COVID aged over 18 years were eligible to participate. For divergent validity analysis, a separate sample of Australians diagnosed with chronic fatigue syndrome (CFS) aged over 18 years were also eligible to participate. Participants were invited to complete the comprehensive baseline assessment outcome measures only on a single occasion on Platform O. Brief ‘pop’ up questions about the comprehensiveness, relevance and comprehensibility of the CCI were included to evaluate content validity. Correlations between CCI scores, WHODAS-36, EQ-5D and the GAS assessed convergent validity. While Long COVID and chronic fatigue syndrome share some symptoms, they are distinctive syndromes whose differences were used to assess divergent validity.&#x0D; Results: The face and construct validity of the CCI was tested in a small sample (n=20) at Western Health. Further validation is currently underway (n=260 consumers) to ensure its quality prior to broader scale up of the DisCOVeRY-SM, and these results will be reported in this conference paper. &#x0D; Conclusion: The CCI is the first co-produced PROM for people with Long COVID, and specifically reflects their needs and priorities. Rigorous validation of this measure will support its broader dissemination both within and outside of Australia, to enable people with this syndrome to receive integrated, high quality and individually tailored care.

Hand function and quality of life in patients with diabetes mellitus before and during the COVID-19 pandemic.

This study aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on patients with diabetes mellitus using patient-rated outcome measures focusing on hand function and quality of life, as well as patients' mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. It was a part of a longitudinal research involving patients with diabetes mellitus living in Sapporo, Japan. Among the 594 patients surveyed before the COVID-19 pandemic from March to June 2019, 417 patients who could be re-surveyed from March to June 2021 were included. We compared the patient-rated outcome measures, namely the Hand10 for hand function and EuroQol five-dimension questionnaire for assessing quality of life in the same population of patients with diabetes mellitus, before and during the COVID-19 pandemic. The results indicated no deterioration in the Hand10 (3.9 vs 3.6) and quality of life scores (0.89 vs 0.9), including mobility (1.25 vs 1.17), self-care (1.1 vs 1.08), pain/discomfort (1.43 vs 1.35), and anxiety/depression (1.21 vs 1.2), during the COVID-19 pandemic when compared with the pre-pandemic values. Usual activity values on the EuroQol five-dimension subscale significantly improved during the pandemic compared to those before the pandemic (1.21 vs 1.12, p<0.01). This study highlighted the effects of the COVID-19 pandemic on patients with diabetes mellitus by comparing patient-rated outcome measures in two different social situations. Patients with diabetes mellitus living in Sapporo, Japan maintained hand function and quality of life by continuing their usual activities during the COVID-19 pandemic.

Protocol for a double-blinded randomised controlled trial investigating the use of adjunct bicarbonate in carpal tunnel release: a single-centre study

IntroductionThis study aims to compare the effectiveness of buffered and non-buffered long-acting local anaesthetics in pain relief during and after carpal tunnel release (CTR) surgery. Carpal tunnel syndrome (CTS) is...

Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review

BackgroundThe design and efficacy of orthotic intervention to non-surgically manage adult and pediatric trigger finger vary widely. PurposeTo identify types of orthoses (including relative motion), effectiveness, and outcome measurements used to non-surgically manage adult and pediatric trigger finger. Study DesignSystematic review. MethodsThe study was undertaken according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement and registered with the International Prospective Register of Systematic Reviews Registry, number CRD42022322515. Two independent authors electronically and manually searched, and screened 4 databases; selected articles following pre-set eligibility criteria; assessed the quality of the evidence using the Structured Effectiveness for Quality Evaluation of Study; and extracted the data. ResultsOf the 11 articles included, 2 involved pediatric trigger finger and 9 adult trigger finger. Orthoses for pediatric trigger finger positioned finger(s), hand, and/or wrist of children in neutral extension. In adults, a single joint was immobilized by the orthosis, blocking either the metacarpophalangeal joint or the proximal or distal interphalangeal joint. All studies reported positive results with statistically significant improvements and medium to large effect size to almost every outcome measure, including the Number of Triggering Events in Ten Active Fist 1.37, Frequency of Triggering from 2.07 to 2.54, Quick Disabilities of the Arm, Shoulder and Hand Outcome Measure from 0.46 to 1.88, Visual Analogue Pain Scale from 0.92 to 2.00, and Numeric Rating Pain Scale from 0.49 to 1.31. Severity tools and patient-rated outcome measures were used with the validity and reliability of some unknown. ConclusionsOrthoses are effective for non-surgical management of pediatric and adult trigger finger using various orthotic options. Although used in practice, evidence for the use of relative motion orthosis is absent. High-quality studies based on sound research questions and design using reliable and valid outcome measures are needed.

Readability of Persian Oxford Elbow Score Using Health Literacy Questionnaire

Objectives Readability and understanding of the questions by patients are determining factors in choosing a patient-rated outcome measure. This can be done using Flesh Reading Ease Score (FRES) in English. In place of this software in other languages, we aimed to assess the readability of the Persian-Oxford elbow score (OES) using the validated health literacy questionnaire. Over 110 million speakers widely speak this language from more than six Middle Eastern countries. Methods We enrolled 60 patients with elbow and 60 with non-elbow conditions as the control group. Patients rated each of the 12 items of the EOS on a 3-point Likert scale as very little, moderate, and very good in response to “How understandable was the question to you?”. The rating was compared with the health literacy score, which was categorized as insufficient, not enough, sufficient, and excellent health literacy. Results Testing readability of individual items of the OES showed that the median readability of each item was 3 out of 3 (very good) for all 12 items. There was no significant difference between an elbow and non-elbow involvement (P=0.17), which was suggestive of very good readability of the EOS by the general population, even if the patients have not experienced the symptoms. Moreover, there was no significant difference among different levels of health literacy which is suggestive of very good readability of OES even when the health literacy was insufficient. Conclusion OES readability is very good and high enough to be understandable by different levels of health literacy, education levels, and different age groups. Persian-EOS can be used confidently for initial and follow-up assessments of elbow conditions.

Personal recovery, clinical recovery and patient-rated measures

AbstractThis talk will cover two common areas of confusion. First, the relationship between personal recovery and clinical recovery will be described, using recent meta-analytic evidence. It will be argued that personal recovery is not the same as clinical recovery, and that there is now an established policy and practice consensus that supporting personal recovery is the primary aim of mental health systems. Traditional clinical recovery-oriented treatments which target for example symptomatology or relapse prevention can for many people with mental health issues contribute to their recovery at points in their lives, but for others different approaches are needed. This variation in clinical need is addressed in the second area – patient-rated measures. The rationale for measures of experiential knowledge will be given. A distinction will be drawn between Patient-rated outcome measures (PROMs) and Patient-rated experience measures (PREMs), and between peer-developed patient-generated PROMs (PG-PROMs) compared with those developed by non-peer research teams. It will be argued that modern mental health systems should be judged by their impact on recovery, as measured using PROMs and PREMs in preference to staff-rated measures.Disclosure of InterestNone Declared

Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Upper Extremity Functional Index.

Introduction The Upper Extremity Functional Index (UEFI) is a region-specific questionnaire for patients with upper extremity disorders including patients with rotator cuff-related pain (RCRP). We aimed to translate and cross-culturally adapt the UEFI into Greek (UEFI-Gr) and evaluate its reliability and validity in a Greek-speaking population with RCRP. Methods Published guidelines for translation and cross-cultural adaptation of patient-rated outcome measures were followed. One hundred two patients were asked to complete the Greek versions of the UEFI; Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; and RAND 36-Item Health Survey. Internal consistency, test-retest reliability, measurement error, content validity, concurrent validity, and ceiling and floor effects were evaluated. Results Minor linguistic discrepancies were identified and adopted in the Greek language. The UEFI-Gr presented high internal consistency (Cronbach's alpha: 0.93), excellent test-retest reliability (intraclass correlation coefficient: 0.91; 95% confidence interval {CI}: 0.79-0.95), and acceptable measurement error (standard error of measurement: 4.9 points; minimal detectable change {MDC}: 13.8 points). No ceiling or floor effects were detected. Strong correlations were found with the Greek versions of the Disability of the Arm, Shoulder, and Hand questionnaire (r=0.629; p<0.001) and weak to moderate correlations with most subdomains of RAND 36-Item Health Survey (r=0.30-0.59; p<0.05). Conclusions The UEFI-Gr is a comprehensive, reliable, and valid self-reported instrument to evaluate symptoms in patients with RCRP. Further research on the responsiveness of the questionnaire is necessary.

Results of primary radial corrective osteotomy in Madelung's deformity.

The purpose of this study was the evaluation of surgical outcomes in a series of wrists with Madelung's deformity treated with radial corrective osteotomy. We hypothesize that this surgical technique is a suitable and safe way of treatment. A retrospective review of patients with Madelung's deformity treated with radial corrective osteotomy between January 2001 and June 2017 at a single large department of hand surgery in Germany was performed. Patients who met the inclusion criteria were invited for follow-up and outcome variables including pain, range of motion, patient-rated outcome measures, and radiographic measurements were obtained for comparison with preoperative data collected from the patients' medical records. 14 wrists were included. The average age at the time of surgery was 21.9years, and the average follow-up was 7.2years. The average visual analog pain scale at rest decreased from preoperative 2.6 points to postoperative 0.7 points. Under strain, the average VAS declined from 7.4 to 4.9 points. The mean DASH Score decreased from 42.9 before surgery to 22.0 points after surgery. Range of motion improved slightly in five out of six directions of motion, with the greatest increase seen in average supination from preoperative 68.5° to postoperative 82.0°. Averages of all five measured McCarroll's parameters and ulnar variance decreased, as expected from corrective surgery. Four wrists (26.8%) needed subsequent procedures. Radial corrective osteotomy was a suitable treatment of Madelung's deformity in our collective, although surgical outcomes are not yet fully satisfying.

Early and mid-term results with the ATTUNE total knee replacement system compared to PFC Sigma: a prospective comparative study

PurposeUp to 20% of all patients are not satisfied with the result after total knee arthroplasty (TKA). To improve patient satisfaction manufacturers have modified prosthesis design. The ATTUNE prosthesis is a modified version of the PFC Sigma. Aim of this study was to evaluate the outcome at 6 months and 5 years after TKA with ATTUNE compared to PFC Sigma.MethodsSixty patients were included prospectively (30 ATTUNE vs. 30 PFC Sigma). Knee Society Score and Hospital for Special Surgery Score were recorded preoperatively, at 6 months and at least 5 years postoperatively. At 5-years follow-up X-rays in two planes were evaluated, radiolucent lines were documented.ResultsPatient characteristics were similar in both groups. Both ATTUNE and PFC Sigma provided good to excellent clinical results. There were no statistically significant differences based on the overall scores and patient rated outcome measures. Nevertheless, patients in the ATTUNE group tended to be symptom-free earlier and to achieve better clinical results after 5 years.ConclusionEven with the scores not being significantly different here, the modified design of ATTUNE could increase long-term satisfaction with the implant and reduce the need for revision surgery. However, long-term results are required to prove this.

Clinical Outcomes of Arthroscopic Ligament-Sparing Dorsal Capsulodesis for Partial Scapholunate Ligament Tear.

Introduction Various wrist arthroscopy techniques can be used in the management of scapholunate ligament (SLL) partial tears but their success has not been proven. Arthroscopic techniques including thermal shrinkage are becoming more popular in the management of partial SLL injuries. We hypothesized that arthroscopic ligament-sparing capsular tightening yields reliable and satisfactory results for the management of partial SLL tears. Methods A prospective cohort study was conducted on adult (age ≥18 years) patients with chronic partial SLL tears. All patients failed a trial of conservative management consisting of scapholunate strengthening exercises. Patients underwent an arthroscopic dorsal capsular tightening of the radiocarpal joint capsule radial to the origin of the dorsal radiocarpal ligament and proximal to the dorsal intercarpal ligament by either thermal shrinkage or dorsal capsule abrasion. Demographic data, radiological outcomes, patient-rated outcome measures and objective measures of wrist range of motion (ROM), and grip and pinch strength were recorded. Postoperative outcome scores were collected at 3, 6, 12, and 24 months. Data are reported as median and interquartile range, and comparisons were drawn between baseline and last follow-up. Clinical outcome data were analyzed using a linear mixed model method, while radiographic outcomes were assessed with nonparametric analysis with p < 0.05 indicating statistical significance. Results Twenty-three wrists (22 patients) underwent SLL treatment by thermal capsular shrinkage (19 wrists) or dorsal capsular abrasion (4 wrists). Median age at surgery was 41 years (range: 32-48) and median follow-up time was 12 months (range: 3-24). Pain significantly decreased from 62 (45-76) to 18 (7-41) and satisfaction significantly increased from 2 (0-24) to 86 (52-92). Patient-Rated Wrist and Hand Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand significantly improved from 68 (38-78) to 34 (13-49) and from 48 (27-55) to 36 (4-58), respectively. Median grip and tip pinch strength significantly increased at final review. Range of movement and lateral pinch strength were satisfactory and maintained. Four patients required further surgery for ongoing pain or reinjury. All were successfully managed with partial wrist fusion or wrist denervation. Conclusion Arthroscopic ligament-sparing dorsal capsular tightening is a safe and effective treatment for partial SLL tears. Dorsal capsular tightening demonstrates good pain relief and patient satisfaction while improving patient-reported outcomes, grip strength, and maintaining ROM. Longer term studies are required to determine the longevity of these results.

Interpreting patient-rated outcome measures in adolescent patients following concussion

ABSTRACT Objective To estimate scale scores for patient-reported outcome (PRO) measures that classify patients as improved or unimproved at days 3 and 10 post-concussion. Methods Data from 187 adolescent patients who sustained a concussion (150 males, 32 females, 5 not reported) were analyzed. Patients completed the Pediatric Quality of Life Inventory (PedsQL), PedsQL Multidimensional Fatigue Scale (MFS), Headache Impact Test (HIT-6), and Global Rating of Change (GROC) on days 3 and 10 post-concussion. Dependent variables: PedsQL total score, 3 MFS subscale scores [general (MFS-GF), sleep (MFS-SLF), cognitive (MFS-CF) fatigue], and HIT-6 total score. Higher scores on PedsQL and MFS indicate better health; lower scores on HIT-6 indicate less impact on headache-related health. GROC ascertained patient-perceived magnitude of change in health status since concussion. Receiver Operating Characteristic Curve analyses estimated PRO cut-point scores that classified patients as improved or unimproved. Results Day 3 PRO cut-points: PedsQL total = 90; MFS-GF = 73; MSF-CF = 85; MFS-SLF = 81; and HIT-6 total = 54. Day 10 PRO cut-points: PedsQL total = 91; MFS-GF = 85; MFS-CF = 85; MFS-SLF = 90; and HIT-6 total = 51. Conclusions Our results define PedsQL, MFS, and HIT-6 scores as they relate to perceived improvement following concussive injuries. Cut-point scale scores help clinicians interpret concussion PROs and make informed decisions during the management of patients with concussion.

Dynamic stabilization of the painful thumb: A historical and evidence-informed synthesis

Study DesignExpert opinion IntroductionThumb carpometacarpal joint (CMC) osteoarthritis is a common condition seen in the hand therapy clinic. Prevalence is generally higher in females, and the percentage rises for post-menopausal females. Patients typically present with pain and functional difficulties. Conservative management is recommended before a surgical consult. Evidence is mounting that a dynamic stability modeled approach has a significant effect on pain and improving function. PurposeThe purpose of this paper is two-fold: first, to present the history and development of a dynamic stabilization model for treatment of the patient with thumb CMC osteoarthritis (OA), and second, to provide expert clinical commentary and recommendations for the treatment of thumb CMC OA in light of the best available evidence. MethodsExpert clinical commentary is based on an extensive review of relevant literature. ResultsThe current literature and expert opinion supports an evidence-informed multimodal intervention: modalities, pain relief techniques, manual release, joint mobilizations as deemed necessary, neuromuscular re-education through proprioceptive exercises, and education in joint protection principles. ConclusionA rationale for a dynamic stabilization approach is presented. The unique anatomy of the thumb deserves finely tuned care based on high quality research. To advance our knowledge and clinical skills we must not become stagnant, but continue to generate high level evidence. The standard for future thumb CMC OA studies should be well-defined intervention parameters, consistent documentation, and the use of appropriate patient-rated outcome measures.

PEARL: A randomised phase 3 trial of palliative care early in advanced lung cancers (ALTG/TOGA 13/008).

12020 Background: Early referral to palliative care was associated with improved health-related quality of life (HRQL) and overall survival (OS) in a US phase 3 trial in lung cancer patients (pts). International studies in mixed cancer types have reported conflicting results. PEARL aimed to determine whether early referral to palliative care would improve HRQL, OS, and resource use in Australian pts with recently diagnosed, advanced thoracic cancers. Methods: Eligible participants (pts) in this unblinded, multi-centre, randomised, phase 3 trial had advanced thoracic cancers diagnosed within 60 days, and the ability to complete patient-rated outcome measures (PROMS). Pts were randomly allocated to early referral to palliative care (ER) or referral at clinician’s discretion (DR). All pts received standard oncological care. PROMS were completed at baseline, every 3-4 weeks for 6 months, then 6-8 weekly. The primary objective was to determine the frequency of sustained, substantial improvements in HRQL, defined as a 5-point improvement in the FACT-L Trial Outcome Index (TOI) maintained for at least 2 consecutive assessments. Secondary outcomes included OS, documentation of advanced care plan (ACP), PROM scores at 12 weeks, anxiety/depression (PROMIS-ED), lung cancer symptoms (FACT-L), global HRQL (ICECAP-SCM), carer-satisfaction and burden, and understanding of illness and prognosis. The accrual target of 200 gave 80% power (alpha 0.05) to detect an absolute improvement of 20% in the proportion of pts achieving the primary endpoint. Results: 113 pts and 78 carers were recruited when the trial closed for slow accrual. Pt characteristics were well balanced: 88 (75%) had NSCLC, 18 (16%) small cell and 7 (6%) mesothelioma. Median age was 69 (IQR 62-74), 63 (56%) were male; systemic anti-cancer therapy ongoing or planned in 88 (78%). Median follow-up was 30 months. First consultations with a palliative care specialist within 60 days of diagnosis occurred in more pts assigned ER vs DR (57% vs 3.5%). Sustained substantial improvements in FACT-L TOI were reported by similar numbers of pts assigned ER vs DR: 33% vs 32%, p = 0.9. OS was similar among those assigned ER versus DR (median 12 vs 18.4 months, p = 0.11). A similar % had a written advanced care plan at death: 15/40 (39%) vs 15/33 (47%). We found no important differences between arms in global HRQL (ICECAP-SCM), depression/anxiety (PROMIS-ED), lung cancer symptoms (FACT-L), carer satisfaction (FAMCARE-2), carer burden (CRA), or understanding of illness by carers or pts. Conclusions: Early referral to palliative care, compared with discretionary referral, did not improve important outcomes for Australian thoracic cancer pts or carers. Our findings suggest that the palliative care needs of such pts were addressed equally well by delayed referral when clinically indicated, resulting in reduced burden for resource-limited specialist palliative services. Clinical trial information: ACTRN12617000166370.

Clinical update on psychiatric outcome measurement: what is the purpose, what is known and what should be done about it?

To provide a clinical update on the purposes, evidence-base and recommendations for both clinician and patient-rated outcome measures in psychiatric practice. Private and public sector funders have implemented outcome measurement systems in Australian mental healthcare, in order to improve cost-effectiveness. It is important to consider the ultimate aims of outcome measurement from various perspectives in evaluating the evidence-base, as there are a number of measurement dimensions to address. For individual clinicians, the purpose may be to guide treatment-planning, as well as to assess treatment and clinician efficacy. For patients, the purpose is to assess outcomes in terms of their goals for recovery, as well as to evaluate their satisfaction with the care provided, and their healthcare providers. The other orthogonal dimensions of measurement comprise, the proximal to illness measures of symptomatic severity, and the distal measures of disability, which apply to both clinician and patient outcomes. In turn, these measures may be used by healthcare funders in public or private sectors as proxy measures of the cost-effectiveness of psychiatric care provided. Clinical registries linked to service-mapping would provide better data for patients, providers and funders to assess the availability and effectiveness of psychiatric care in Australia.

The Effects of Postoperative Physician Phone Calls for Hand and Wrist Fractures: A Prospective, Randomized Controlled Trial.

BackgroundIn this study, we sought to determine if postoperative physician phone calls following hand and wrist fracture surgery improve patient outcomes, satisfaction, and treatment adherence.MethodologyWe prospectively enrolled 24 consecutive adult patients who underwent outpatient surgery for isolated hand and wrist fractures at a single, metropolitan, safety-net hospital over one year to receive an additional physician phone call starting on postoperative day one. We measured preoperative and postoperative Brief Michigan Hand Questionnaire (bMHQ) composite score, overall satisfaction on a five-point Likert scale, compliance with treatment recommendations, presence of complications, discharge instructions reading level, and clarity of discharge and follow-up instructions. The surgical team was blinded to the treatment arm.ResultsThe bMHQ score improved 26% after surgery; however, there was no difference in absolute score change between groups (12.2 vs. 6.5, p = 0.69). Most patients were satisfied throughout all stages of care, but postoperative satisfaction did not differ between groups (1.4 vs. 2.5, p = 0.21). There was a stronger correlation between patient hand function and satisfaction starting one month after surgery (R2 = 0.502, p = 0.002) than preoperatively (R2 = 0.252, p = 0.029). Immediately following surgery, most patients stated that discharge instructions were clear, and the average readability was below the average patient education level. Despite this, 13% removed their splint or Kirschner wires, 67% did not follow up within a week of recommendation, 62% did not complete postoperative treatment, and 33% had complications.ConclusionsPostoperative phone calls by physicians did not improve compliance with recommendations, patient-rated outcome measures, or clinical outcomes among our hand and wrist fracture patient population.

Effects of COVID-19 on Patients in Adult Ambulatory Psychiatry: Using Patient-Rated Outcome Measures and Telemedicine.

Introduction:To examine the effects of coronavirus disease 2019 (COVID-19) on patients in an academic psychiatric ambulatory clinic, data from a measurement-based care (MBC) system were analyzed to evaluate impacts on psychiatric functioning in patients using telemedicine. Psychiatric functioning was evaluated for psychological distress (brief adjustment scale [BASE]-6), depression (patient health questionnaire [PHQ]-9), and anxiety (generalized anxiety disorder [GAD]-7), including initial alcohol (U.S. alcohol use disorders identification test) and substance use (drug abuse screening test-10) screening.Methods:This observational study included MBC data collected from November 2019 to March 2021. Patient-Reported Outcome Measures (PROMs) were examined to determine changes in symptomatology over the course of treatment, as well as symptom changes resulting from the pandemic. Patients were included in analyses if they completed at least one PROM in the MBC system.Results:A total of 2,145 patients actively participated in the MBC system completing at least one PROM, with engagement ranging from 35.07% to 83.50% depending on demographic factors, where completion rates were significantly different for age, payor status, and diagnostic group. Average baseline scores for new patients varied for the GAD-7, PHQ-9, and BASE-6. Within-person improvements in mental health before and after the pandemic were statistically significant for anxiety, depression, and psychological adjustment.Discussion:MBC is a helpful tool in determining treatment progress for patients engaging in telemedicine. This study showed that patients who engaged in psychiatric services incorporating PROMs had improvements in mental health during the COVID-19 pandemic. Additional research is needed exploring whether PROMs might serve as a protective or facilitative factor for those with mental illness during a crisis when in-person visits are not possible.

Greek physiotherapists’ contemporary knowledge and practice for lateral elbow tendinopathy: An online survey

ObjectivesTo investigate physiotherapists' current knowledge and practice in the management of patients with lateral elbow tendinopathy, to explore associations between the participants’ education and management preferences and to identify potential evidence-to-practice gaps by making comparisons with recent research recommendations. DesignAn on-line cross-sectional survey. SubjectsRegistered physiotherapists working in Greece with previous experience in the management of lateral elbow tendinopathy. ResultsThree hundred and seventy eight responses met the inclusion criteria. Most responders (70.4%–91.5%) use pain provocation tests for the diagnosis of the condition, while a limited proportion uses patient rated outcome measures (6.9%–13%). Supervised exercise is the mainstay of rehabilitation (92.6%), followed by adjunctive research recommended treatment techniques such as manual therapy (72%) and advice (59.5%). Up to 83.6% of participants use adjunctive treatment techniques that are not recommended or without research recommendation (such as electrophysical agents, ice etc.). Physiotherapists with post-graduate education in musculoskeletal physiotherapy are almost three times more likely to choose only research recommended treatment approaches. There is a lack of consensus in an optimal exercise programme (type, volume, duration etc.) in patients with lateral elbow tendinopathy. ConclusionDespite research recommendations a limited use of patient rated outcome measures in lateral elbow tendinopathy is recorded. Supervised exercise is the first line treatment option for most physiotherapists, although the optimal application is still unclear. A large proportion of physiotherapists apply adjunctive treatment techniques that are either ineffective or poorly researched suggesting a substantial evidence-to-practice gap. Better access to knowledge, organisational and peer-support can potentially help to bridge this gap.

High variability in patient reported outcome utilization following hip fracture: a potential barrier to value-based care.

Osteoporotic hip fractures are associated with high levels of morbidity, mortality, and cost, while gains in mortality over the past 30years have been modest. To improve care beyond simple mortality metrics requires identifying and then consistently measuring outcomes that are meaningful to patients and families. The purpose of this study was to review the top-tier hip fracture literature published in the past 30years to determine if there are consensus outcome measures being routinely used and if the rate of reporting clinically meaningful patient-rated outcome measures is improving over time. This was a systematic review and meta-analysis on outcome measures reported in osteoporotic hip fractures. Articles were included if they had been published over the last 30years and were from high impact factor journals. Inclusion criteria were elderly hip fractures, therapeutic or prognostic study, unique and identifiable patients, and included follow-up beyond initial hospitalization. We analyzed study type, inclusion criteria, outcomes reported, and journal specialty orientation. Three hundred eighty-four articles were included in the final analysis. Sixty-seven percent of the articles were therapeutic studies; 33% were prognostic studies. The average number of patients in each study was 435; the average age was 78years. The most commonly reported outcome was mortality, and was present in 79% of studies. There was a high degree of heterogeneity in patient-reported outcome measures, with the most popular score (Harris Hip Score) reported only 14% of the time. Only 6% of articles had all components of essential core outcome sets previously defined in the literature. Despite the apparent advances that have been made in our ability to care for hip fractures, the overall rate of reporting outcomes beyond mortality rate remains low. This lack of consensus represents a major barrier to implementation of value-based care in this patient population.

Face Validity of Gujarati Version of Lower Extremity Functional Scale (LEFS)

Background: Lower extremity functional scale (LEFS), originally developed by Binkley et. al in 1999,is a valid Patient rated outcome measure (PROM) for various musculoskeletal conditions. The scale isoriginally developed in English languageand has been translated and cross culturally adapted into manylanguages. In India, the scale is still applied in the original language, i.e. English, and also in its originalform. Hence, the need of the study is to find the face validity of Gujarati translated LEFS in accordancewith functional activities of Gujarati population.Methodology: Individuals referred to Physiotherapy clinic and having lower limb musculoskeletalcondition were screened for the eligibility. Those who fulfilled the inclusion and exclusion criteriawere included in the study. Face validity of Gujarati LEFS was calculated by asking the individuals tograde items of Gujarati translated LEFS according to 5-point Likert scale, including very important,important, relatively important, slightly important and unimportant, as how each item appear to themfor measuring lower extremity function.Results: Item impact score for each item was calculated from frequency and mean item importancescore. Item impact score of:· 15 out of 20 items was more than 1.5· 5 out of 20 items scored less than 1.5Results show statistically significant need to change the items of Gujarati translated LEFS.Conclusion: 5 out of 20 items in Gujarati translated LEFS needs to be modified/eliminated for itsimplication into Gujarati population.